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Early diagnosis of invasive mould infections and disease
Frédéric Lamoth1,2, Thierry Calandra1
1Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Abstract:
Invasive mould infections (IMIs), such as invasive aspergillosis or mucormycosis, are a major cause of death in patients with haematological cancer and in patients receiving long-term immunosuppressive therapy. Early diagnosis and prompt initiation of antifungal therapy are crucial steps in the management of patients with IMI. The diagnosis of IMI remains a major challenge, with an increased spectrum of fungal pathogens and a diversity of clinical and radiological presentations within the expanding spectrum of immunocompromised hosts. Diagnosis is difficult to establish and is expressed on a scale of probability (proven, probable and possible). Imaging (CT scan), microbiological tools (direct examination, culture, PCR, fungal biomarkers) and histopathology are the pillars of the diagnostic work-up of IMI. None of the currently available diagnostic tests provides sufficient sensitivity and specificity alone, so the optimal approach relies on a combination of multiple diagnostic strategies, including imaging, fungal biomarkers (galactomannan and 1,3-β-d-glucan) and molecular tools. In recent years, the development of PCR for filamentous fungi (primarily Aspergillus or Mucorales) and the progress made in the standardization of fungal PCR technology, may lead to future advances in the field. The appropriate diagnostic approach for IMI should be individualized to each centre, taking into account the local epidemiology of IMI and the availability of diagnostic tests.
Insights
Diagnosing invasive mould infections (IMIs) in immunocompromised patients is challenging. A combination of imaging, biomarkers like galactomannan, and molecular tools like PCR offers the best approach for early detection and treatment.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Hematology Oncology
Background:
- Invasive mould infections (IMIs) pose a significant mortality risk for immunocompromised individuals, particularly those with hematological cancers.
- Early diagnosis and treatment are critical for improving patient outcomes in IMI management.
- Current diagnostic methods for IMIs face challenges due to diverse fungal pathogens and host presentations.
Purpose of the Study:
- To review the diagnostic challenges and current strategies for invasive mould infections (IMIs).
- To highlight the importance of combining multiple diagnostic modalities for optimal IMI detection.
- To discuss the potential of emerging molecular tools in IMI diagnosis.
Main Methods:
- Review of current diagnostic techniques for IMIs, including imaging (CT scans), microbiological methods (culture, PCR), and histopathology.
- Evaluation of fungal biomarkers such as galactomannan and 1,3-β-d-glucan.
- Discussion of advancements in molecular diagnostics, including PCR for filamentous fungi.
Main Results:
- No single diagnostic test for IMIs offers sufficient sensitivity and specificity.
- A multimodal diagnostic approach combining imaging, biomarkers, and molecular tests is recommended.
- Standardization of fungal PCR technology shows promise for future diagnostic improvements.
Conclusions:
- Effective management of IMIs requires a combination of diagnostic strategies tailored to individual patient and institutional factors.
- The development of standardized PCR assays for filamentous fungi represents a significant advancement in IMI diagnostics.
- Individualized diagnostic approaches considering local epidemiology and test availability are essential for optimal IMI care.